GLP-1 agonists offer morbidly obese patients a new path to weight loss before hip or knee replacement, but delayed stomach emptying creates anesthesia risks surgeons must plan around.
Delayed gastric emptyingGLP-1 drugs slow stomach emptying, creating aspiration risk during anesthesia — surgeons must follow specific perioperative protocols for patients on these medications.
What the researchers found
GLP-1 receptor agonists have emerged as an effective weight loss option for morbidly obese patients with hip or knee osteoarthritis who need joint replacement surgery. These patients typically present earlier in life, have more severe symptoms, and experience worse surgical outcomes after total hip or knee arthroplasty.
Beyond weight loss, GLP-1 agonists may have anti-inflammatory and disease-modifying effects on osteoarthritis itself. The review covers single GLP-1 agonists, dual GLP-1/GIP agonists, and triple GLP-1/GIP/glucagon agonists in development.
However, a critical perioperative concern is GLP-1-related delayed gastric emptying, which affects anesthesia timing for elective joint replacement surgery. Surgeons must account for this when planning procedures in patients taking these medications.
Why it matters
As GLP-1 drugs become the dominant weight loss treatment, orthopedic surgeons will increasingly encounter patients on these medications before joint replacement. This review fills an important gap by addressing both the potential benefits — weight loss and anti-inflammatory effects that could improve surgical outcomes — and the practical safety concern of delayed gastric emptying that could complicate anesthesia.
How the study worked
Narrative review examining the current landscape of GLP-1 receptor agonists and related multi-agonist drugs, their effects on obesity and osteoarthritis, and perioperative considerations for total joint arthroplasty surgeons.
Who was studied
Morbidly obese patients with hip or knee osteoarthritis who are candidates for total joint arthroplasty
What this study cannot tell us
This is a narrative review rather than a systematic review or meta-analysis, so it does not comprehensively quantify treatment effects. The evidence for GLP-1 agonists as disease-modifying agents for osteoarthritis is still emerging. Specific perioperative protocols for GLP-1 patients undergoing arthroplasty are based on limited data and expert opinion.
How to read the evidence
This is a narrative review providing a clinical primer for surgeons. It synthesizes existing evidence but does not conduct a systematic search or meta-analysis, limiting the strength of its conclusions.
When this study was published
Published in 2024, this review reflects the current GLP-1 landscape including newer dual and triple agonists. Highly relevant as these drugs become increasingly common before elective surgery.
The bigger picture
With millions of people now taking GLP-1 drugs, every surgical specialty must adapt. This review is part of a growing wave of specialty-specific guidance on managing GLP-1 patients perioperatively. It also highlights the intriguing possibility that these drugs do more than cause weight loss — they may directly modify joint disease through anti-inflammatory pathways.
Questions still open
- How long before surgery should GLP-1 drugs be paused to safely eliminate the gastric emptying risk?
- Do GLP-1 agonists genuinely modify osteoarthritis progression, or is the benefit purely from weight loss?
- Will preoperative GLP-1-driven weight loss translate into better long-term joint replacement outcomes compared to bariatric surgery?
Common questions
Can GLP-1 drugs help with osteoarthritis beyond weight loss?
Why are GLP-1 drugs a concern for joint replacement surgery?
Read the original research
Glucagon-Like Peptide Receptor-1 Agonists Used for Medically-Supervised Weight Loss in Patients With Hip and Knee Osteoarthritis: Critical Considerations for the Arthroplasty Surgeon.
Arthroplasty today, 27, 101327
Citation
Heckmann, Nathanael D; Palmer, Ryan; Mayfield, Cory K; Gucev, Gligor; Lieberman, Jay R; Hong, Kurt. (2024). Glucagon-Like Peptide Receptor-1 Agonists Used for Medically-Supervised Weight Loss in Patients With Hip and Knee Osteoarthritis: Critical Considerations for the Arthroplasty Surgeon.. Arthroplasty today, 27, 101327. https://doi.org/10.1016/j.artd.2024.101327